Hajni Erdélyi on Perinatal Physiotherapy, Belgium
Hajni Erdélyi, physiotherapist specialising in perinatal physical therapy and pelvic health, located in Brussels, Belgium.
In Belgium, physiotherapy is considered an integral part of supporting a woman during pregnancy, birth, and postpartum. Prescribed by a general practitioner or OB-GYN during pregnancy, physiotherapy is a part of routine perinatal care in Belgium regardless of whether a woman is experiencing pain or injuries.
When integrated into a woman’s pregnancy and postpartum journey, physiotherapy has been shown to help heal aches and pains, help prevent leakage with pelvic floor muscle training, check your pelvic floor muscle contraction technique, help manage prolapse symptoms if you have them, check your abdominal muscles, create an exercise plan for you with modifications if needed, help with birth preparations and teach you perineal massage, provide recovery advice for the postnatal period, and support your mental health both before and after birth.
Hajni Erdélyi, a local physiotherapist specialising in perinatal physical therapy and pelvic health, shares her wisdom on the benefits of physiotherapy in preparation of and recovery from childbirth, as well as an overview of how the system works in Belgium. She’s a mother of two girls and the survivor of stillbirth.
“For me, everything starts with the body, connecting with the wisest, most intelligent and powerful resource we have, right in front of us. I’m the translator between you and your body.”
What inspired you to become a physiotherapist?
I was good at biology in high school and interested in medicine, but I didn’t want to be a doctor. I knew I couldn’t sit all day, so movement and healing were two cornerstones for me.
What is physiotherapy?
For me, physiotherapy is a part of medicine that helps to heal and repair the body to function again normally, freely, and without any pain. There are many different specifications in physiotherapy. I specialise in perinatal physical therapy and pelvic health, helping women during pregnancy, birth, and postpartum recovery.
“My goal is to create a safe place for women to connect with their body, heal, change and transform. My mission is to empower women, holding their hands until they find their own power and freedom to birth, to heal, to desire, to say no, to be WHOLE, to be enough and more.”
How many sessions are funded for women in Belgium? And how do you recommend allocating the sessions (before and/or after birth)?
Women in Belgium are offered nine sessions of physiotherapy through the basic insurance system. It’s more than a lot of other countries offer, but in my opinion it’s still not enough.
If there are no problems or pain during pregnancy, I meet with a woman for four sessions in pregnancy to prepare for birth and delivery of the baby and then five sessions in postpartum, starting six weeks after birth. There are also physiotherapists that work in the hospital that will see a woman after birth during her hospital stay.
I often find that five sessions after birth isn’t enough. If we find there’s a pelvic floor problem, lower back pain, or another kind of dysfunction, it’s recommended to continue physiotherapy.
How do women in Belgium learn about physiotherapy?
Physiotherapy is prescribed in the hospital or at the six-week postpartum check-up. It’s commonly recommended by your doctor or OB-GYN, or through word of mouth from other mothers. It’s also discussed in hospital leaflets and health insurance.
Can you talk us through what typically happens during a physiotherapy session in pregnancy?
I work a bit differently and more extensively than the ‘normal’ system, opting to extend a mother’s sessions further than the nine sessions if possible.
I’ll usually meet with someone at the end of their second trimester or the beginning of their third trimester and the first thing I do is find out how they want to birth.
During these prenatal appointments, we always start with an assessment to discover if there’s any pain or discomfort. If there is, we focus on treating that first. Next, we work on preparation for delivery: labour positions, pushing and breathing techniques, and pelvic floor and abdominal exercises. I encourage women to come for at least one session during pregnancy so that they can learn how to move their bodies properly during pregnancy, especially if she’s unsure of how or what to move.
During the first prenatal session, I educate women on correct ergonomics during pregnancy and how to move their bodies during pregnancy.
During the second session, I go through labour stages and both standing and seated positions to use during labour. I teach women two or three positions they can do in the bed if they get an epidural - this knowledge helps them to actively be a part of the birth even if movement is restricted. If the partner is available, I recommend they attend the session as well and I assist them in trying out the positions together (showing where to put hands and how to breathe together). I teach couples between 10 and 15 positions to use during labour, and although a woman will usually only use one or two, having the knowledge of a wide range of positions enables her to choose what works best for her. I also show her how to sit during pregnancy to make enough space for the baby.
“If you don’t practise, the information will stick in your head and you know what you should do, but you can’t do it because you feel the pain from the contractions. This is why it’s so important to practise exactly how you can bring ease into your body before labour.”
During the second and third sessions, I focus on pushing techniques, breathing techniques, and how to protect the abdominal muscles. We work on how to hold your legs and hips properly during labour to have the best opening and positioning for the baby. During this session, I want women to feel the difference between correct and incorrect positioning in their body.
“Birth preparation is about feeling and knowing the movements so that when you’re in labour, your body already knows what to do.”
During the fourth session, I educate women on what’s going to happen in the hospital, what you need to do right after birth to close your pelvis, and how to stand up after delivery (waiting two hours before doing so). I explain how to pee for the first time post-delivery and when you can expect to have your first stool. We also go over the best pelvic floor exercises to use for recovery during the first six weeks. The most crucial part of postpartum is the first two-three hours after delivery, and then the first two-three days when there’s a hormonal surge, so it’s important for women to begin doing exercises for abdominal diastasis and the pelvic floor. It doesn’t have to be extensive, just two minutes a day.
“Perinatal physiotherapy is about giving freedom to women and inner knowledge that we were once capable of giving birth naturally - and we can still do it, but we need to connect with our body.”
And what happens during a physiotherapy session postpartum?
Normally, there’s a physio who works for a couple of hours at the hospital who will come and see a woman during her postpartum period (to teach her how to do abdominal and pelvic floor exercises). Theoretically, you see a physio during your hospital stay before you go home, although this doesn’t always happen.
The most important period for the body is the first six weeks following birth. If you don’t know how to protect yourself and your body (especially if it’s not your first child and you have to take care of siblings, as well), it can be detrimental to your physical health and recovery. The first six weeks postpartum is when women should be working on regeneration by doing the basic exercises that I teach during pregnancy.
During postpartum, women have five physiotherapy appointments, starting at six weeks after birth. My job during this time is to educate, prepare and enable women to do whatever they want with their bodies. I check for abdominal diastasis and pelvic floor function and begin abdominal exercises and pelvic floor re-education.
“Postpartum women are given exercises to support movement safely, gaining control over their bodies again, learning what is and isn’t normal, and knowledge, support, and understanding in their new body.”
I always check the belly and abs for abdominal diastasis. Physiotherapy works with the deepest level of the abdominal muscles, the transversus abdominis, which is a muscle that wraps around your entire lower abdomen and back, acting like a corset to hold all the internal organs. It’s important to close abdominal diastasis because if it doesn’t close properly and the corset is weak, you’ll have lingering lower back issues. The lower part of the transversus abdominis is connected to the pelvic floor. So, if you’re doing the work with your abs, you’re simultaneously doing work on the pelvic floor. I work with the abs first and then begin pelvic work on the tenth or twelfth session to allow for recovery post-birth. With five postpartum sessions, I can teach women what to do at home to fully close the abdominal diastasis and reactivate the pelvic floor.
The lower transversus abdominis is like a triangle that functions for two things - vomiting and birthing. Years ago, if a woman was having trouble pushing during birth, midwives would put a feather into the woman’s throat to induce vomiting because it uses the same muscle and would simultaneously push out the baby.
What are the benefits of physiotherapy during pregnancy?
Slowing down and reconnecting with your body, learning to trust your body and accept the new condition you’re in, and finding comfort and power for delivery. Physio can also reduce pain during pregnancy, which is important because pain can lead to stress and mental health issues, which then affect mother-child bonding.
You shouldn’t have to deal with pain in pregnancy. Even if we can’t alleviate the pain 100%, you can find some ease in your body through physiotherapy.
What are the benefits of physiotherapy during the postpartum period?
First of all, the mother gets to leave the house! In meeting with a physiotherapist, she connects, gets help and support, and has someone to listen to her. This reduces the risk of postpartum depression and postpartum anxiety, and increases emotional and mental health during the postpartum period. She also learns to connect with her changed body, finding a way back to function and joy in movement. If there are serious injuries from birth, physio can heal and repair any damage.
“Physiotherapy helps a woman to feel more at home in her body, reconnecting with who they are and learning to recognise and feel more in control over their body physically, which then empowers them mentally and emotionally to feel more like themselves.”
If something in your body doesn’t work properly, it can create anxiety and fear - contributing to a woman feeling out of control. As a physiotherapist, I’m empathetic and understanding of what she’s going through - I let her know what’s normal and help to project where she’ll be in one or two months.
“Sometimes you just need someone to say “I know what you mean. You can be where you are right now because it’s going to be better. You need to stay here and build up from this point.”
What’s the ideal amount of postpartum sessions to fully support a woman’s recovery (for a healthy woman with no issues or pain)?
Once a week up to six months after birth, when a woman will be able to do most activities.
Pull out box:
Want to protect your pelvic floor when pregnant/postpartum? Here are some things you should avoid:
Jackknifing out of bed
Bending without muscle support
Running before your pelvic floor is ready
Sit ups and crunches
Wearing a baby on your front for hours (especially if having major abdominal diastasis)
Do you need to have physical issues or symptoms (like back pain or bladder leakage) to benefit from physiotherapy, or is it something every mother should incorporate into their care during pregnancy and beyond?
Every mother-to-be should have physiotherapy - absolutely! Everybody deserves it and benefits from it!
Pull out box:
At-home exercises to support your postpartum physical healing
Abdominal suction: Keep your spine straight (lying in bed with feet out in front), pull your navel to your spine with exhalation, then hold it for 5-10-15 seconds (with breath or without).
Squeezing pelvic floor: Lay in bed, feet out in front, and squeeze the pelvic floor in and up.
Standing tabletop with a table: Placing hands on a table and step back – keep your back horizontal, feet under hips, and stretch back (you can do abdominal suction too).
A study showed women who participated in an eight-week postpartum programme that included specialised exercises from a physiotherapist found significant improvement in wellbeing scores and depressive symptoms. The number of women identified as ‘at risk’ for postnatal depression pre-intervention was also reduced by 50%. Why do you think postpartum physiotherapy can have such a profound impact on mental and emotional wellbeing for mothers?
I’m so happy to bring up this study because I think the most important thing with a physiotherapy appointment is that the mother leaves the home and isn’t isolated. I’ve had mums who came for a postpartum session and cried the entire session, and that was the most healing thing she needed at the time. Connection, support, and surveillance are the most important parts of postpartum wellbeing, and physiotherapists and midwives are generally first in line to detect mental problems during this time. Everyone has bad days, new mothers often have more. So through the appointments, we’re able to see if there’s something out of the ordinary, and if there is, we can raise awareness or recommend they check in with a specialist.